Studies

DANAMI-2

Primary percutaneous coronary intervention (PCI) has been shown to be superior to fibrinolysis in the treatment of ST-segment elevation myocardial infarction (STEMI) patients when it can be delivered in a timely manner by an experienced team. However, the advantages of primary PCI are less certain when there are delays associated with its administration. The DANish Acute Myocardial Infarction 2 (DANAMI-2) study compared fibrinolysis within hospitals with transfer to invasive-treatment centres for PCI. The average distance between referring hospitals and invasive-treatment centres was 50 km and up to 150 km.

Recruitment of patients to the DANAMI-2 trial was stopped ahead of schedule when the third interim analysis showed a significant benefit of PCI in the subpopulation of patients from referring hospitals.

The 30-day clinical outcomes support primary PCI over fibrinolysis for STEMI patients, even when the patients have to be transported from a local hospital to an invasive-treatment centre. The superiority of PCI over thrombolysis was driven by a 75% reduction in re-infarction, whereas the reductions in death and stroke did not reach statistical significance.

DANAMI-2: Clinical outcome at 30 days (n=1572)

At long-term follow-up (median time 7.8 years), the benefit of primary PCI over fibrinolysis was maintained. There was a statistically significant reduction in re-infarction, whereas the reduction in death did not reach statistical significance.

(N.B. Stroke was not considered in the long-term follow-up as a clinical diagnosis could not be extracted from the registries.)